Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

G
Transportation Patterns and Problems of People with Disabilities

INTRODUCTION

Transportation is an extremely important policy issue for those with disabilities. People with disabilities have consistently described how transportation barriers affect their lives in important ways. Over the last two decades the National Organization on Disability (NOD) has sponsored three successive Harris polls with people with disabilities, and respondents in each survey have reported that transportation issues are a crucial concern. In the last survey, undertaken in 2004, just under a third of those with disabilities reported that inadequate transportation was a problem for them; of those individuals, over half said it was a major problem. The more severe the disability of the respondent was, the more serious were the reported transportation problems (National Organization on Disability-Harris Interactive, 2004).

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

these travelers often revolve around dichotomies that may be misleading—arguing over the role of buses compared with the role of paratransit, for example. Moreover, these debates often focus on some topics at the expense of other equally important issues. For example, there is a legitimate concern about ensuring that people with disabilities receive the services mandated by the 1990 Americans with Disabilities Act (ADA), but most of the transportation needs of these travelers are not addressed at all by the ADA. Colored by this perspective, many policy analyses ignore the fact that most travelers with disabilities, as is true for travelers in the world at large, make the majority of their trips in private vehicles and rely heavily on walking to facilitate their use of all modes of travel. A narrow policy focus tends to limit discussions of the barriers to both auto use and pedestrian travel while slighting the connection between transportation programs and other important policy initiatives, from land use planning to human and medical service delivery.

To expand traditional discussions, this paper makes a clear distinction between the kinds of transport services and facilities that are required by regulations or law and those that are required to address the far larger mobility needs of most people with disabilities. This paper not only highlights the value of understanding and enforcing the ADA (and related legislation) but also indicates when and why policy discussions must go beyond a focus on the ADA to address the full spectrum of the needs of travelers with disabilities. The paper also suggests that providing effective mobility options for those with disabilities requires attention to a variety of interrelated policy areas and service delivery models: from how, when, and where medical services are provided to the places where people are able to live.

This paper addresses local ground transportation; beyond its scope are issues of air, sea, and intercity travel for people with disabilities. It has three major sections. The following section gives an overview of the travel patterns of people with disabilities, highlighting the problems that they face with various modes of travel and the crucial role of both walking and private vehicles in their mobility—whether or not they drive. The next major section, the third in this paper, examines the community transportation resources provided to travelers with disabilities by public transportation systems, other public and nonprofit agencies, and the private sector. The final section suggests that more and better accessible transportation is a necessary but not a sufficient resource for overcoming the multiple barriers faced by most people with disabilities. Addressing the transportation needs of such travelers requires active cooperation between transportation planners and those in a number of other policy and program arenas. Relevant personnel range from educators to medical personnel, from employment counselors to urban designers, and from housing remodelers to land use planners.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

THE TRAVEL PATTERNS OF PEOPLE WITH DISABILITIES

In 2000 just over 8 percent of those ages 5 to 20 years, 19.2 percent of those ages 21 to 64 years, and 41.9 percent of those ages 65 years and over reported some level of disability (U.S. Census Bureau, 2002). As is well known, the older people are, the more likely they are to report a disability and the more severe it is likely to be; for example, 40 percent of those ages 65 to 69 with a disability reported that their disability was severe, whereas over 60 percent of those ages 80 and over who reported a disability reported that their disability was severe (U.S. Census Bureau, 2005). Unfortunately, knowing that a person has a disability, even if it is severe, does not tell us whether that person faces significant mobility constraints. As a result, it is difficult to clearly link disability rates to specific mobility problems. For example, a significant number of people with disabilities so serious that they cannot walk far or use public transit can and do drive (Rosenbloom, 1982; OECD, 2001). On the other hand, some people have such severe disabilities that they cannot leave their houses without substantial assistance, which may mean that their transportation concerns are secondary to the other barriers they face.

Moreover, barriers to mobility have complicated causes. The 2004 NOD-Harris Interactive poll found that almost two-thirds of all the people with disabilities who reported major transportation problems had annual incomes below $35,000. For those with higher incomes, reported transportation problems dropped markedly, as did the differences in transportation problems between those with and without disabilities (National Organization on Disability-Harris Interactive, 2004 [computed from Table 6c]). Earlier work found the same patterns; both the U.S. Congressional Budget Office (U.S. CBO, 1979) and the U.S. Senate Select Committee on Aging (1970) concluded that almost all transportation problems among the elderly or those of any age with disabilities were related to income alone; reported transportation problems dropped drastically with rising income, even controlling for age, physical disability, and health status. Of course, income may well be related to the severity of personal disability but probably not in a linear fashion.

Overall, we have limited information on the travel patterns of people with disabilities. The data that we do have tend not to differentiate travel by the degree of severity of a person’s disability, household income, driver’s license possession, car ownership, and other significant variables that might affect mobility—such as sex and age. However, two major studies give us some background information: a 1994 disability supplement to the annual National Health Interview Survey (NHIS) and a 2002 congressionally mandated study undertaken by the Bureau of Transportation Statistics of the U.S. Department of Transportation. In addition, we have some useful data

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

on the patterns of older drivers facing declining driving skills because of increasing illness or disability. These studies are discussed below.

Overall Travel Patterns

To develop policy-relevant data on disability, in 1994 four federal agencies jointly undertook a supplemental survey (NHIS-D) to the annual NHIS (NCHS, undated). Phase II of that supplement dealt with transportation (and other) concerns.1 The NHIS-D asked detailed questions about the transportation needs and barriers among people with self-reported disabilities and impairments (U.S. National Center for Health Statistics, undated). The NHIS-D data show that 19 percent of adults under age 65 had problems in “getting around outside … home due to [their] impairment or health problem.” The single most frequently cited reason was difficulty inwalking; over 75 percent of those who said that they had difficulties getting around reported walking problems. The respondents were also questioned about other possible reasons for their difficulties in getting around (multiple responses were sought and permitted), but none was nearly as important: 13 percent reported vision problems and 10 percent reported cognitive ormental problems.

Two-thirds of NHIS-D respondents under age 65 who reported the existence of one or more disabling conditions drove a car every day or occasionally. Among the 29 percent who reported never driving, roughly 45 percent said that they did not drive because of their impairment or health problem. Among those who did drive, even if infrequently, less than 2 percent said that they needed or used a special vehicle or special equipment on their car to allow them to do so.

The dependency on the car may be related to the low level of public transit available to respondents (although cause and effect may be difficult to determine). Roughly a third of NHIS-D respondents said that there was no public transportation available in their area. But even among the majority who did report having transit, most said that they did not use it—although their health or disability was not the reason for nonuse. Over three-fourths of those who had public transit in their area said that they had not used it all during the past 12 months; only 6 percent reported using a regular bus, 1.3 percent a subway, and 0.9 percent an accessible bus at least once in the previous week. Only 16 percent of those respondents

1

All data were calculated for this article from Section B, Transportation, of the 1994 Disability Phase II Adult Public Use File available on the website of the Centers for Disease Control and Prevention; the website also explains all sampling procedures, data handling, and variance estimation strategies. See http://wonder.cdc.gov/wonder/sci_data/surveys/nhis/type_txt/dfs94-b.htm.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

who had not used available public transit reported that their failure to do so was related to their impairment or health problem.

Among those who ever used public transit, even if rarely, only 13 percent reported difficulty in doing so. Among the small number of those respondents who either had difficulty in using transit or could not use it because of their disability or health condition, the single most frequently cited problem was difficulty in walking. The second most frequently cited problem was needing help from another person (multiple responses were sought).

Roughly the same number of respondents reported the availability of other transportation alternatives—and they made slightly more use of them. Almost two-thirds of NHIS-D respondents reported that there were special bus, taxi, or van services for people with disabilities available in their area. The respondents most frequently mentioned services provided by the public transit authority but also identified programs offered by other governmental and private entities. Among those who did have such services in their area, only 10 percent reported using any of them at all in the last 12 months; only 1.2 percent had used such services at least once in the previous week. In fact, the respondents mentioned that they were almost twice as likely to use a regular taxi for which they had to pay full fare as a subsidized or special transportation option. Among the 90 percent who had not used special services, over 9 out of 10 explained that they had either not needed or not wanted to use the services. Although multiple responses were sought, few respondents gave additional reasons for their nonuse of specialized transport services.

In 2002 the U.S. Bureau of Transportation Statistics (BTS) undertook a congressionally mandated comparative study of the travel patterns of people of various ages with and without disabilities; BTS interviewed 5,019 people, of whom 2,321 reported having disabilities ranging from mild to severe.2 The study found that people with disabilities traveled less and reported more mobility problems than those without disabilities. But some disabilities were so severe that people were unable or unwilling to leave their houses; almost 2 million people, or roughly 4 percent of those with a self-reported disability, were homebound—including 9 percent of those ages 65 and over. Although over two-thirds of those under age 65 left their homes almost daily, 7 percent of those under age 25, 15 percent of those ages 25 to 64, and over 25 percent of those ages 65 and over left their homes only once or twice a week (Sweeny, 2004, Table A1).

2

The BTS study was undertaken by use of the computer-assisted telephone interviewing technique between July and September 2002. Survey weights were developed to reduce several sources of bias (nonresponse, no telephone in the household, etc). Full details on the weighting and variance estimation procedures are available in U.S. BTS (2003b).

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

On the other hand, the BTS study found that among those with disabilities of any severity, over 70 percent of those ages 25 to 64 and roughly 60 percent of those age 65 and over were currently drivers (Sweeny, 2004, Table A8) (driving status was attributed to those who reported driving; it was not based on licensing status). Only 13 percent of people with disabilities lived in a household without a car, and over 20 percent lived in a household with three or more cars (U.S. BTS, 2003a, Table 35). Table G-1 clearly indicates how dependent travelers of all ages were on a car, van, or truck, although the data do not indicate the frequency of use or the percentage of all trips taken by any travel mode. Over three-fourths of all travelers under age 65 and almost that share of those ages 65 and over rode in a car at least once in a month as either a driver or a passenger. Among those ages 25 to 64, over two-thirds drove a car at least once during that month.

Conversely, no more than one in five individuals ages 25 to 64 used general public transportation (public bus, subway, light right, or commuter rail) and only 8 percent of those over age 65 did. The figures were far lower for specialized and ADA paratransit use; no more than 10 percent of any cohort of people with disabilities used these modes in a month. On the other hand, walking was a major mode for travelers with self-reported disabilities of all ages. (If a traveler using a wheelchair traveled somewhere without using another mode [i.e., not in a bus, car, train, etc.] the trip was categorized as a walking trip.)

TABLE G-1 Travel Modes Used in the Past Month by People with Disabilities

Percentage of People

Mode

Under 25

25–64

65+

Personal vehicle (driver)

49.1

68.6

55.6

Personal vehicle (passenger)

89.6

77.5

70.5

Carpool, vanpool

28.7

8.8

3.6

Public bus

20.9

12.8

5.8

ADA paratransit

3.7

5.3

7.2

Other specialized services

2.6

4.0

2.9

Private or chartered bus

6.3

3.9

4.7

School bus

24.6

1.9

0.0

Subway/light rail/commuter rail

9.5

7.1

2.0

Taxicab

8.6

12.4

8.2

Electric wheelchair, scooter, golf cart

2.0

0.8

1.0

Bike

48.0

15.9

3.7

Walk

56.0

47.9

37.7

Other transportation

12.0

5.4

2.8

NOTE: Multiple responses were permitted; the sample sizes were very small.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Auto use, often as the driver, was even higher for medical trips among all travelers with disabilities. Among those ages 25 to 64, for example, almost 9 out of 10 travelers reported using a personal vehicle to travel to the doctor and drove that vehicle almost 70 percent of the time. Less than 2 percent reported using ADA or other specialized paratransit to travel to a doctor, and no more than 4 percent took a public bus (Sweeny, 2004, Table A12). Dependence on a private vehicle was even higher among people with disabilities who were employed; over 80 percent used a private vehicle to commute, driving the vehicle in which they were riding roughly half the time. No one under age 25 and only 2 percent of those ages 25 to 64 used ADA or specialized paratransit services for their work trips; only 7 percent of those under age 25 and less than 6 percent of those ages 25 to 64 used public transport (Sweeny, 2004, Table A11).Table G-2 shows that being a driver did not fully explain the reliance on a private vehicle by people with disabilities. While drivers with disabilities were more reliant on the car than nondrivers, the dependency on the private vehicle by nondrivers is clear. These data were not published by age, and as in Table G-1, they do not indicate the percentage of trips taken by each mode or the frequency of modal use. Several patterns are obvious nonetheless. Almost every current driver drove at least once during the previous month. Moreover, drivers

TABLE G-2 Transportation Mode Used by Drivers and Nondrivers with Disabilities in the Past Month

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

were substantially more likely to be either a driver or a passenger in a personal vehicle than to use buses, paratransit, or taxis.

Many drivers, however, did report that they also used a variety of public transit modes, although nondrivers were more likely to report using buses, specialized paratransit modes, and other alternatives. At the same time, nondrivers with disabilities were remarkably reliant on the car—and even more so if we add taxi use to the mix. Over 86 percent of nondrivers were passengers in a car, 16 percent rode in a car- or vanpool, and almost 22 percent used a regular taxi during the previous month. In contrast, less than 13 percent of nondrivers used ADA paratransit services and under 7 percent used other community paratransit services in that month.

The BTS also asked if respondents with disabilities needed help with or had trouble getting needed transportation. Roughly 9 percent of those under age 25, 14 percent of those ages 25 to 64, and 32 percent of those ages 65 and over answered yes. The most frequent reasons for those troubles were having no car, having no or limited transportation, and havingno one on whom to depend (multiple responses were permitted). Roughly 14 percent of those ages 25 to 64 and 7 percent of those ages 65 and over said that they didn’t want to ask for help; a somewhat smaller percentage reported that their equipment doesn’t fit transportation (unspecified) or disability makes it hard to use (unspecified). Far fewer of those who said that they needed help reported any difficulties with bus or taxi service or fear of crime; 8 percent said that costs (unspecified) were too high (Sweeny, 2004, Table A7).

Overall, these studies show that people with disabilities do face important travel barriers, but not necessarily those on which the policy debates have most centered. Roughly one-third of people with disabilities have no public transportation or other transportation available to them, so the accessibility of those services is beside the point. At the same time, the rate of use of these modes is not high among those people who do have such services in their areas, and only a small percentage mention their disability or health status as the reason for nonuse. In fact, most travelers with self-reported disabilities either drive themselves or take the majority of their travel in private cars. The most significant transportation problems mentioned (either overall or for the nonuse of public transit) are barriers in the pedestrian environment, which far outnumber reported problems with transit or paratransit modes (although they may well explain the lower rates of use of those modes).

Driving and the Aging of Society

The data presented above make it clear how reliant people with disabilities of all ages are on the private car. However, we also know that

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

older people in every industrial country have become increasingly more dependent on the private car to maintain their mobility (ECMT, 1999; OECD, 2001; Rosenbloom and Stähl, 2003; Gagliardi et al., 2005). Older people make the majority of their trips in a car, and the vast majority of older people are licensed to drive; in fact, within two decades older drivers will constitute one in four drivers on U.S. highways (and will constitute substantially more drivers in states like Florida and Arizona) (Stutts, 2005; Herbel et al., 2006). Linked to this increased “automobility” is the growth of almost every indicator of travel among the elderly: trips made, miles traveled, and time spent in a vehicle (Hu and Reuscher, 2004), coupled with a dramatic decrease in the use of public transit. For example, the share of all trips taken by older people using public transit fell by half between 1995 and 2001 (Rosenbloom, 2004).

With the increasing number of older drivers, however, comes a growing concern with both safety and the mobility losses that will accompany driving cessation. Older drivers below age 80 have fewer crashes per capita than those ages 18 to 25 years; moreover, the per-capita crash rates among drivers over age 65 have dropped substantially over the last few decades (Evans, 1991; IIHS, 2000; Li et al., 2003; Dellinger et al., 2004; Stutts, 2005). However, many driving skills do diminish, on average, with age. Per exposure (miles driven), older drivers tend to have higher crash rates than middle-aged people (but they have crash rates roughly comparable to those of young drivers) (Ranney and Pulling, 1990; Evans, 1988; Johnson, 2003; O’Neil and Dobbs, 2004). In short, many of the rapidly increasing number of older people who have long relied on driving to meet their needs may face serious mobility problems as they as they age and experience increasing disability (Rosenbloom, 2006a).

It is important to note that a major reason for the lower per-capita crash rates among the younger cohorts of older people is that they simply drive less and less often in situations that they find risky. Many studies show that long before retirement people begin to self-regulate, that is, make changes in their travel patterns to accommodate a loss of driving skills or to react to problematic driving situations (De Raedt and Ponjaert-Kristoffersen, 2000; Lyman et al., 2001; West et al., 2003; Henderson, 2004; McKnight, 2003). As a 5-year longitudinal study of older drivers in Britain found,

reduced driving is related to changes in health but the immediate factor in instigating these reductions is a decline in confidence in driving competence. That is, older drivers monitor their performance and react appropriately when they feel that their performance is becoming adversely affected by poor health, or for other reasons (Rabbitt et al., 2002, p. 1).

Moreover, Table G-3 shows that drivers with disabilities, regardless of age, impose more limitations on their driving than do those without dis-

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

TABLE G-3 Types of Driving Self-Regulation by People With and Without Disabilities

Percentage of People

Type of Self-Regulation

With Disabilities

Without Disabilities

Drive less in bad weather

66.3

49.8

Drive less often than before

64.5

32.2

Avoid driving during peak hours

58.0

42.0

Avoid busy roads and intersections

51.7

40.0

Avoid driving at night

51.5

25.8

Avoid driving distances >100 miles

47.2

21.9

Avoid high-speed highways

38.4

21.8

Avoid unfamiliar roads or places

38.0

27.5

Drive slower than speed limits

22.0

14.9

Avoid left-hand turns

11.4

8.4

NOTE: Multiple responses were permitted; the sample sizes were very small.

SOURCE: Table 37, U.S. BTS (2003a).

abilities. Among those with disabilities roughly two-thirds drive less in bad weather and less than they used to; over half avoid rush hour driving, busy roads and intersections, and night driving. Over a third avoid long distance driving, freeways, and unfamiliar places, roughly a fourth drive slower than the speed limit, and more than one in ten avoid left-turns.

Unfortunately, these kinds of self-regulatory behaviors, while perhaps increasing safety, may have significant impacts on mobility. Not all trips that have been postponed can be rescheduled; not all trips originally scheduled during peak hours or in the evening can be made at other times; not all routes avoided have alternative paths to the same locations. In short, the destinations to which it is easy to travel may not be good substitutes for those to which it is difficult or dangerous to travel (Rosenbloom, 2001, 2006a). Moreover, having the ability to choose to travel to more potential destinations generally signals greater mobility—and the reverse results in lower mobility. Thus older people and those with disabilities can suffer important reductions in mobility and access even if they continue to drive. While driving cessation may be the final blow for these travelers, they may have been losing mobility and independence for some time, and these losses should be recognized in policy discussions (Rosenbloom, 2001, 2006a; Rosenbloom and Winsten-Bartlett, 2002).

There is substantial evidence that the final loss of the ability to drive has a significant emotional component, above and beyond mobility losses. A 2003 study for the Department for Transport of the United Kingdom noted, “The main implications of no longer having access to a car are reductions in the choice of destinations, flexibility, and spontaneity of travel and the

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Indeed, driving cessation, particularly among men, has been linked to serious depression and even suicide (Marottoli et al., 2000; Fonda et al., 2001; Johnson, 2003; Ragland et al., 2005). Thus it is easy to understand why many older drivers resist total driving cessatin for as long as possible (Shope, 2003).

At the same time, cause and effect are very difficult to untangle. It is not clear whether the disabilities that contribute to driving reduction or cessation also reduce the ability or desire to travel outside the home. The loss of independence may be multidimensional, and the actual ability to drive may not be the only issue to be addressed. In addition, the disabilities of older people (or of those who are younger) may have different implications for their use of different travel modes. For example, fairly old NHIS data showed that almost 40 percent of people of any age who were too disabled to use public transport actually drove a car (Rosenbloom, 1982); this percentage has likely increased over the last 25 years. In the 1994 NHIS-D, 50 percent more people reported that their impairments created difficulties in walking than reported that their impairments created problems in driving. A major European study commented,

Older people who suffer from limitations related to health must often cease walking or using public transport before they are forced to cease driving. Approximately one-third of women over 80 years of age cannot use walking as a means of transport, but many with a license can still drive (OECD, 2001, p. 128).

It is for these reasons that policy analysts have suggested a variety of ways to enhance the driving of older people facing increasing disabilities. These include improving the roadway network in ways that respond to the special constraints of older drivers, developing aftermarket devices that can be installed on private vehicles to make driving easier (e.g., larger mirrors and swing-out seats), improving the vehicle itself (e.g., through the use of cruise control devices that help prevent rear-end collisions and lane drifting), providing appropriate driver reeducation and retraining programs, and developing car-sharing programs that allow older drivers and those with disabilities to give up their cars while still being able to drive occasionally (Staplin et al., 2001; Rosenbloom, 2005; Stutts, 2005; Herbel et al., 2006). In addition, there are similar vehicle options that make it easier for people with disabilities to ride as passengers in private vehicles (e.g., passenger-side swing-out seats, racks for wheelchairs and other mobility devices), and private vehicles accessible to those who cannot transfer from their wheelchairs). These policy options are central to all discussions of the mobility needs of people with disabilities, those both younger and older than age 65.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

COMMUNITY TRANSPORTATION RESOURCES

This section has three subsections that describe the community transportation resources that exist or that should exist:

The accessible transportation services and facilities that are or that should be provided by public transit operators

Those that are or that should be provided by an array of public and private nonprofit organizations

Those that are or that should be provided by the private sector in ordinary market interactions (e.g., on-street taxis and airport shuttles)

The discussions below have a dual focus: first, the obligations of these providers under ADA, and second, the much larger arena in which these operators could be providing services to enhance the mobility of those with disabilities.

Public Transportation Agencies

When the ADA was signed into law in July of 1990, it gave people with disabilities many of the same kind of rights that the Civil Rights Act of 1964 earlier gave to people of color.3 Title II of the ADA specifically outlaws discrimination on the basis of disability in services, programs, and activities provided by public entities, including local transit operators. Public transit services owned or operated by a public entity (or provided under contract to a public entity by a private operator) must be accessible to individuals with disabilities, including those who use common wheelchairs, as the statute and regulations define accessibility for each mode. Transit operators are also required to ensure that both the pretravel and en route information provided by the system are available in a variety of accessible formats.

The ADA has clearly changed the landscape of public transit; as a national disability organization recently noted:

As a consistent theme in most transit systems across the United States, the Americans with Disabilities Act of 1990 (ADA) has spawned great improvements…. As a result of the ADA, the past decade has brought about real improvements in access to transportation for people with disabilities, and access to public transportation has improved significantly since implementation of the ADA transportation provisions (NCD, 2005, pp. 13, 20).

3

The ADA information summarized in this section comes largely from materials supplied on the website of the U.S. Access Board: http://www.access-board.gov.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

There are many public transit modes: buses and trolley buses, heavy and light rail services, commuter rail, ferry boats, vanpools, and carpools. Each of these modes poses unique access and mobility problems for people with disabilities; there are ADA requirements for each mode, but there is also the potential for many modes to provide more mobility to people with disabilities than that mandated by the law. Of course, the significant cost implications cannot be ignored; as the National Council on Disability (NCD) notes (NCD, 2005), public transit is substantially underfunded in this country, and ADA mandates do not come with any additional funding so there is even less money for additional or nonmandated services. Yet the potential remains high for public transit to make a bigger and better contribution to the mobility of people with disabilities.

Heavy, Commuter, and Light Rail Systems

The ADA requires heavy and light rail systems to make some or all of their vehicles, stations, and transfer points fully accessible to people with disabilities. New systems must be fully accessible, as must be new purchases or new improvements on older systems (although there are some exceptions even on new systems). However, older systems are required to rebuild or retrofit only what are defined as key stations (for example, those with the most traffic or serving major activity centers). Moreover, older rail systems are required to make only a subset of their existing vehicles accessible to people with disabilities, although all new cars must be accessible. As with other travel modes, operators are required to provide accessible communications in many formats, including individual-stop announcements.

Today there are only 685 of these key stations in the United States; this number represents a fraction of the total number of rail stations in older systems. Disability advocates had hoped that the ADA regulations would require a larger number (or all) stations in older systems to be made accessible, but the costs were so high that the number of key stations was a political compromise (NCD, 2005). Clearly, then, the key station requirement, even if it is fully met, does not address the significant rail restrictions facing many travelers with disabilities in older systems, who can enter and exit the system only at a limited number of stations, not necessarily at their preferred origins and destinations; some trips cannot be made at all. As the National Council on Disability has noted, “train travel has improved greatly for people with disabilities, but the ADA’s limited key station requirement has meant that some of the large, old East Coast rail systems in particular, have few accessible stations” (NCD, 2005, p. 14).

Key stations were to be accessible by 1993, but the deadlines have been extended by the U.S. Department of Transportation to 2013 for commuter rail and to 2023 for rapid and light rail systems. However, the Federal

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Transit Administration (FTA) recently reported that “only” 96 key stations (14 percent) in 11 systems still fail to meet accessibility standards (NCD, 2005). Disability advocates, however, do not necessarily agree with the FTA assessment of how well some of those key stations actually meet the ADA requirements.

Continuing to meet ADA standards, even in newer rail systems, is an additional compliance problem; accessibility features—from way-finding devices for those with visual impairments to the mechanisms used to ensure level access into rail cars—require substantial maintenance. For example, over time, the horizontal and/or vertical gaps between the station/stop platform and the floor of the rail vehicle can become too great to allow level entry by a variety of travelers with disabilities without additional devices (such as manual or automated gap fillers, which themselves must be maintained and used properly). If these devices are not properly maintained, they cease to facilitate access by those with disabilities.

Finally, when new heavy or light rail systems or additional rail services are inaugurated, the transit system may decrease or reroute bus services to encourage rail ridership, often requiring modal transfers on trips people previously took without having to transfer. While some of these rerouted buses or the new rail services themselves may provide more or better service for people with disabilities, there is substantial evidence that such changes may in fact harm a large number of disadvantaged travelers from poor or minority communities who are more dependent on bus services. These situations have been the subject of many lawsuits across the United States (Rosenbloom, 1991, 2006b; Lee, 1997; Mann, 1997; TCRP, 1998c; Sanchez et al., 2003). To the extent that travelers with disabilities are members of such disadvantaged communities, they may, too, suffer mobility losses when bus services are reconfigured as rail services are expanded.

Buses

The ADA required public transit operators to purchase only accessible buses after August 1990; as a result over time all fleets should become totally accessible. Most accessible buses in the United States today are regular coaches which offer access by (1) lowering (kneeling) the entrance side of the bus by several inches so that those with difficulty with stairs will have a shorter first step up into the vehicle (particularly if they are boarding from a curb) and (2) providing mechanical lifts at an entrance to the bus for those who cannot climb stairs (including but not limited to those in wheelchairs). However, in 2002 the FTA announced that only 88 percent of all buses met the mandate; thus it is possible that today 5 to 10 percent of all buses in the United States are still not ADA accessible.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

ably the maintenance and operation of accessible buses in service and the training given drivers to operate key accessibility devices. For much of the first decade after the passage of the ADA, the accessibility features of U.S. buses were still subject to substantial malfunctions. That often meant that travelers with handicaps were left waiting at a stop—or perhaps worse, stranded on a deployed lift that could be neither raised nor lowered. Even when a bus started the day with a functioning lift, however, lift problems could occur while the bus was in service.

There is substantial evidence that some drivers were afraid of disabling the bus once it was in service and so refused to cycle the lift at a stop. Or drivers who did not know how to cycle the lift refused to do so, telling a passenger waiting at a stop that the lift was not functional. Still other drivers were afraid that taking time to board a passenger with a disability would cause them to run behind schedule—although this rarely happens with well-maintained equipment, trained and experienced drivers (and/or passengers), and the use of proper scheduling algorithms (Rosenbloom, 1994; TCRP, 1998a). Other drivers would not “kneel” the bus unless a passenger knew to ask (even if system policy required kneeling at all stops). A substantial number would not allow travelers not using wheelchairs to board using the lift. In addition, driver failure to call out stops, as required by the law for travelers with visual impairments, has been a long-term compliance issue.

Many of these problems have lessened over time because of a combination of better equipment, improved maintenance, appropriate and timely driver training, and more serious management surveillance and response. However, passengers with disabilities have reported these same problems fairly recently in a number of systems, including Bi-State Transit (St. Louis), the Detroit Department of Transportation, MARTA (Atlanta), and the MBTA in Boston (NCD, 2005). Moreover, many systems have a significant number of very old buses with very old lift and securement systems that can no longer be repaired and that need to be replaced if the bus is kept in service.

The securement systems aboard buses also pose compliance problems (Zaworski and Hunter-Zaworski, 2006). The ADA requires that each vehicle have a minimum of two wheelchair securement areas and that these systems must accommodate “common wheelchairs.” The regulations also require that drivers be trained to proficiency in the use of these devices. However, there are a variety of user, maintenance, and training problems with these systems. First, securement systems have traditionally had serious operational and maintenance issues; moreover, many drivers do not really know how to work them properly (TCRP, 2003d). While both the technology and driver training have improved over time, these issues remain a concern in many bus systems.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Second, an increasing number of people use very customized wheelchairs that can test securement systems (Zaworski and Hunter-Zaworski, 2006). However, some systems have improved securement use even with unusual wheelchairs through the purchase of improved equipment and better driver training and surveillance. The Phoenix, Arizona, transit system has developed “kits” that wheelchair users can carry with them that show where on their chairs securement devices can be attached and/or that provide ways to appropriately extend the straps that are part of on-board securement systems. In addition, it is generally believed that the FTA has ruled that wheelchair securement is not mandatory if the user chooses to remain unsecured.

However, there are a host of ways in which bus systems could provide better mobility options for travelers with disabilities that go beyond the ADA mandates. Many of those have been identified and evaluated in a series of reports from the Transit Cooperative Research Program (TCRP). First is the need for a very different accessible bus (de Boer, 2004). The United States began requiring bus accessibility before the vehicle technology had advanced sufficiently (although it can be argued that the technology would not have improved in the absence of the ADA). While lowering the first step onto the bus (kneeling) can help some travelers and the lift can work well for those in wheelchairs (and perhaps others), neither option accommodates the full range of people with disabilities or their mobility devices (TCRP, 1994, 1998a).

In most circumstances, low-floor buses, widely available in Europe, would offer better access for many people and mobility aids, as well as for travelers with strollers, baby carriages, suitcases, or bulky packages (Aurbach, 2001; ECMT, 1999). From a curb, entry into a low-floor bus is almost level; even if the traveler enters the bus from the street, the first step onto the flat floor of the bus is (1) the only step required of the traveler and (2) much shorter than the first step on traditional coaches. Manual or powered ramps are available for those who cannot handle the much smaller horizontal and vertical gaps (TCRP, 1994, 1998b). However, low-floor buses have not been widely adopted in the United States. A 2002 TCRP study found that less that 9 percent of the U.S. bus fleet was composed of low-floor buses with ramps in 2002; while there are anecdotal accounts of widespread low-floor bus purchases, the TCRP study did not find a high level of low-floor bus purchases.

Second, studies of older people and those with disabilities strongly suggest the need to improve traditional transit services in several important ways (TCRP, 1997a,b, 1998b,c, 1999a,b, 2002a,b, 2003b; Rosenbloom, 2004). The majority of older people and some of those with disabilities want to travel at different times than most commuters; they need expanded routes and service hours, better schedule adherence, and improved and ap-

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

propriate assistance from drivers. Some bus operators in the United States and abroad have increased ridership by operating smaller buses, allowing passengers to be closer to the driver, which often reduces the anxiety or fear felt by travelers with disabilities (TCRP, 1999b, 2002b). Some transit systems have been successful in replacing traditional bus routes with more carefully targeted community or neighborhood services whose schedules and routes are more focused on the specific needs of older travelers, even if they run only a few days a week (TCRP, 1997a, 1998c).

In addition, many studies show that almost all travelers seek better information on their travel options, both before they leave home and while they are en route (especially at transfer points) (TCRP, 1999a). Studies also show that many older people and those with disabilities who have never used a bus can benefit significantly from different kinds of transit familiarization and training sessions. In fact, several TCRP studies have shown significant and continuing transit ridership among older people and those with disabilities who were provided with targeted training—in some cases even if they were or had been drivers (TCRP, 1998c, 2002a). Finally, many people report being fearful about public transit use. For example, older people and those with disabilities have anxiety not only about crime but also about harassment. People also worry about falling while getting on or off a transit vehicle or while maneuvering to their seat when a bus is in motion. Transit operators need to address all these issues to provide meaningful service to a variety of travelers.

Third, several studies suggest that transit operators should consider providing a range of nontraditional services, from flexible routes and route deviation service to the kinds of service routes adopted successfully in Scandinavian countries and replicated to some degree in many Canadian and a few U.S. cities (TCRP, 2003c, 2004a,b; Rosenbloom, 2004, 2005; see Higgins and Cherrington [2005] for a more pessimistic assessment). Flexibly routed services are not without problems. Bus systems are not generally required to provide complementary paratransit parallel to flexibly routed services. Thus, it is possible for transit systems to use route deviation or flexible services to reduce their paratransit obligations, which might negatively affect those travelers with disabilities who could not use those flexible services. Overall, however, there is evidence that these kinds of services could provide some travelers with disabilities with better mobility options than they currently have (Rosenbloom, 1994, 1995; TCRP, 2004b).

Complementary Paratransit Services

The ADA requires public transit systems to also provide complementary paratransit—that is, special, demand-responsive transportation services—for people who are unable to board even an accessible bus or who

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

do not have an accessible path to an accessible bus. Paratransit services are not required for those unable to access or use available rail services. Complementary paratransit services were clearly meant to provide only a safety net while transit systems became more accessible. However, many people have come to look upon them as a major transportation option; this is unfortunate, because these services are unlikely to be a significant part of the transportation resources of anybody except those with extremely serious disabilities. For those travelers, complementary paratransit services are a lifeline. However, ADA-required complementary paratransit services will play little role in the mobility patterns of the majority of travelers with disabilities because of the ways in which they are provided.

Transit operators must provide complementary paratransit services to eligible users in at least a 3/4-mile corridor paralleling their existing bus routes and during at least the same hours of service that those bus routes operate. Users may only be charged a fare equivalent to double the regular bus fare; and their requests for next-day services must be accommodated—which, depending on the hours of service, can be as little as 12 hours in advance. Systems are allowed but not required to provide same-day service; users must be allowed but are not required to request service 7 days in advance. Transit systems may not impose any restrictions on the type of trip taken. Most importantly, eligible travelers cannot be refused service on the basis of budget restrictions—that is, systems are not allowed to have capacity constraints, even if the costs of meeting the ADA standards are extremely high. The paratransit system may negotiate with riders, asking them to move their trips either an hour early or an hour later than their desired time of travel; otherwise, the system must provide all trips requested by eligible travelers within that time window.

Transit systems meet these mandates in a variety of ways, which often reflect the way they provided services before passage of the ADA, their experiences with the private paratransit providers in their service areas, and the outcomes of actual or threatened legal challenges. With respect to the last point, almost every major metropolitan transit operator has been sued by disability advocates and aggrieved riders over system failure to meet the ADA paratransit requirements. The transit systems of some cities, like that of Boston (MBTA), provide all paratransit services in their own vehicles with their own drivers or in dedicated contractor vehicles because of difficulties in the past with contract providers or regular taxi services. The Chicago Transit Authority provides some ADA paratransit services in system-owned vehicles, while some trips are served by contract providers and others by regular taxis called directly by users. The transit system of Austin, Texas (Capital Metro) provides some services in system-owned vehicles, usually to passengers who need accessible vehicles, and contracts with other private providers or taxi operators to serve passengers who can ride in sedans.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

aUnlinked trips (e.g., having to transfer buses or transfer from a bus to a train on the way to work creates two unlinked trips; the more transfers the more unlinked trips created by just a one-way journey to work).

bData are from four Los Angeles-area reports.

SOURCE: Computed for this study from the FTA 2004 National Transit Database.

Almost every system has found the complementary ADA paratransit requirements to be extremely costly because (1) they involve high ongoing operating costs and (2) there are limited opportunities for economies of scale. Paratransit tends to be expensive because it is difficult to group trips efficiently without making passengers ride or wait too long, miss their appointments, etc. The larger and lower density the paratransit service area is, the more difficult it is to carry many passengers in a vehicle per hour or mile of service; this substantially raises the cost of each trip provided. Moreover, passengers with serious disabilities tend to take longer to board and deboard, which also lowers productivity. As a result of these service features, the average one-way paratransit trip cost in the 50 largest U.S. transit agencies was $29.28 (calculated from unpublished data in FTA’s 2004 National Transit Database). In other words, taking the average eligible traveler with disabilities to and from one doctor’s visit would cost almost $60.

Table G-4 describes the 2004 cost and ridership data for 10 representative cities in the United States;4 it shows that average trip costs are generally

4

Some of these systems may be providing non-ADA paratransit services or may be allowing non-ADA-eligible riders (such as the elderly) to use their ADA-required services. The National Transit Database does not make this clear.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

high. Indeed, total paratransit service expenses are a significant component of total transit system operating costs, even though paratransit riders are a small percentage of the total system ridership. Individual system costs for a one-way ADA-required paratransit trip ranged from a high of $47 in Cleveland, Ohio, to a low of $14 in Birmingham, Alabama; the average cost per one-way trip in the 10 cities was $30.81. Paratransit riders accounted for a low of 0.1 percent of the total system ridership in Atlanta to a high of 4.1 percent in Birmingham. However, paratransit service costs accounted for approximately 4 percent of total system operating costs in Chicago but over 17 percent of total system operating costs in Austin and Tucson, Arizona. For the 10 systems, the average percentage of total operating costs incurred to provide paratransit service was 9.2 percent for an average of 2 percent of the total system ridership. Even Birmingham, which had the lowest unit cost in the table, spent over 11 percent of its annual operating budget for the 4 percent of its ridership who used paratransit services.

Because of these costs many transit operators failed to even come close to meeting the ADA standards for at least a decade; for example, they routinely refused service for eligible travelers who called for next-day service and often gave preference to riders who made frequent recurrent trips (because they could be prescheduled). Although service has improved in most systems, sometimes as the result of lawsuits, a BTS study (U.S. BTS, 2003b) found that 53 percent of travelers with disabilities reported experiencing significant problems with ADA-required paratransit services, including the failure of the vehicle to show up during the permissible pickup window or even to show up at all. Over 40 percent reported the same problems for their return trips. About 6 percent said that service was not available when it was needed, and 4 percent said that they could not get through to make a reservation on the telephone.

Ironically, after 1990 many transit systems initially provided complementary paratransit service to travelers throughout their service area at a low fare because, prior to the implementation of ADA, they had been required to provide some paratransit services to the elderly and those with disabilities as a condition of federal funding. In general, most systems had previously provided fairly low levels of paratransit service; but at the same time, they tended not to be very strict about limiting eligibility and served a large area, often where they had no bus services at all (Rosenbloom, 1994). After the passage of the ADA, many systems kept those system parameters, for both practical and political reasons, in essence controlling costs by not meeting mandated service levels for those who were eligible for services under ADA.

However, as more systems have been required to actually provide ADA-mandated levels of service, the high costs have forced many systems to raise fares to the maximum allowed, restrict services to the minimum required,

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

and adhere to very strict rider eligibility guidelines (TCRP, 1998a). As systems have cut paratransit coverage to the minimum, they have excluded a very large number of people with disabilities because so few live within or can travel to the minimum 3/4-mile corridors along an existing transit route to receive ADA-mandated paratransit service (Bogren, 1998; Rosenbloom, 2005).

Transit systems have also cut paratransit costs by implementing very strict, and even onerous, certification processes to determine paratransit eligibility for those who do live near (or can travel to) areas where bus services (and, thus, complementary paratransit) services are provided. A recent report by the National Center for Transit Research concludes that exceeding the minimum ADA requirements substantially increases ridership and, thus, costs (Thole and Harvey, 2005). While the report does not actually urge systems to cut service, raise fares, or increase the difficulty of becoming eligible for service, it makes clear the cost savings that will result from doing so. The report describes a number of transit systems that have managed to reduce their total paratransit ridership by instituting multistage and difficult eligibility procedures, raising fares to the maximum allowed, or cutting service quality (e.g., not allowing same-day service).

King County (Seattle, Washington), for example, changed its eligibility process to require a preapplication process and a telephone interview follow-up for all applicants. The county also substantially increased the number of applicants who were required to report in person for a functional evaluation at a medical center under contract to the transit operator (rather than accepting an evaluation from the rider’s own doctor). As a result of these changes, the monthly rate of certification of new riders as eligible fell by half and the process removed the eligibility of 3,200 existing riders (Thole and Harvey, 2005). The NCD (2005) also describes a number of (different) systems that have undertaken restrictive actions and similar sharp reductions in the number of new or existing riders certified or recertified as eligible for paratransit service.

Clearly, these practices may result in decisions that discriminate against people genuinely eligible for paratransit services; the NCD has expressed concerns over this possibility (NCD, 2005). However, it is likely that a far larger number of potentially eligible travelers are simply discouraged from pursuing the complicated process at all; this problem is far more difficult to address. Moreover, many of those who are discouraged from applying for fear of being refused as well as those actually refused (re)certification may sometimes have serious disabilities but they just do not meet the strict requirements of the ADA for paratransit services. In short, the vast number of people with disabilities are already excluded from these services, many without being able to meet their mobility needs using public transit as it is currently delivered.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

At the same time, the enormity of expanding paratransit service to provide rides to the vast number of people with disabilities is shown in Table G-5, which ultimately provides a very conservative estimate of the cost of expanding services to meet the needs of a wider range of people with disabilities. Table G-5 illustrates the costs of responding to the needs of people age 15 years and older with a severe disability in the major city served by each transit agency. The calculation assumes that only people with a severe disability are eligible for parastransit services under ADA. Indeed, some people with severe disabilities (as defined by the U.S. Census Bureau) may not meet the ADA criteria, while others with less serious disabilities may, but this is generally a reasonable and conservative estimate.

The calculations are conservative in another way; all of the agencies shown in Table G-5 serve a geographic area larger than the major city; these estimates, however, include only those who live in that large city. Matching the actual service area of each transit agency to census tracts to calculate the “real” number of potential riders is a task far beyond this paper, but doing so would simultaneously substantially increase the number of potential riders and significantly lower the average number of rides provided to all those aged 15 years and over with severe disabilities. In addition severe disabilities numbers were calculated using national rates by age but not by sex or race or ethnicity, which could well vary markedly by city. As a result these figures are only a gross, but conservative, calculation.

Table G-5 shows that only 1 of the 10 systems (that in Tampa, Florida) provides even one round trip a year to everyone with a severe disability in the large city in the center of its service area. The rest of the systems provide even less service to those with disabilities. In reality, most ADA-required complementary paratransit systems provide many trips to a few frequent riders, while they fail to serve the vast number of potentially eligible people or even those who have been certified as eligible. (Several studies have found that many people who become registered for the service never or rarely use it, probably because of its inherent limitations.) Building on these data, we can calculate that providing each person with a severe disability in the central city of each of the listed transit agency’s service areas with one round trip per month would be staggeringly expensive. The Los Angeles regional transit operator, for example, currently spends over $68 million per year to provide ADA-mandated (and related) paratransit services; were it to offer only one round trip per month to everyone in the City of Los Angeles aged 15 years and over with a severe disability, the yearly cost would be $331 million or almost five times its current expenditures. If Los Angeles regional transit operator were to offer those travelers four round trips per month, the cost would be $1.3 billion annually.

These figures illustrate a number of points. First, they explain why so many local transit systems have failed to meet ADA complementary

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

aOne ride is one unlinked trip (e.g., having to transfer buses or transfer from a bus to a train on the way to work creates two unlinked trips; the more transfers the more unlinked trips created by just a one-way journey to work).

bData are from four Los Angeles-area reports.

SOURCE: Computed for this study from the FTA National Transit Database; 2003 American City Survey Data Profiles; and U.S. Census Bureau, 2005 (Table 1, Prevalence of Disability).

paratransit requirements and why, once they are forced to do so, they become extremely restrictive in their service parameters and eligibility. The figures also indicate how unlikely it is that most transit systems will expand their paratransit services beyond the minimum, even as the population of travelers with disabilities climbs, unless additional funding becomes available. Second, these figures suggest that policy makers must consider more

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

cost-effective transportation measures for those who can use them, such as improving public transit services in the ways suggested above, while facilitating car use by those who do not live in areas where transit services can reasonably be provided. Third, these cost data also indicate the need to augment and strengthen the services of the other community transport providers that, by leveraging the resources of volunteers, can often provide less expensive (but still not cheap) paratransit services to many people with disabilities who are not eligible for ADA-mandated complementary paratransit services for a variety of reasons.

Other Community Providers and Obligations

Social and Human Service Agencies

Public transit systems are not the only agencies that provide transportation services to those with disabilities. A vast array of public and nonprofit human, medical, and social service agencies provide transportation to people who use their programs or qualify for their services; the U.S. General Accounting Office (Siggerud, 2003; U.S. GAO, 2004) has identified 70 to 80 federal programs that allow state and local grantees to use grant funds for transportation services, most of which are provided to disadvantaged people (but not necessarily those with disabilities). For example, the Job Access and Reverse Commute Program of the U.S. Department of Transportation has funded over 200 state and local recipients to provide transportation for disadvantaged people, including those with disabilities, to access job and job training sites. The Administration on Aging, as another example, allows its program funds to be used to provide transportation services to older people. These social and human service agencies also have responsibilities under the ADA; they are not required to buy or own accessible vehicles, as long as their system, “when viewed in its entirety,” provides the same level of service to those needing accessible vehicles as to its more general riders.

The Beverly Foundation annually undertakes a study of how what they call Supplemental Transportation Programs (STPs) for the elderly are organized, managed, and financed across the United States; they have identified many exemplary service models. These range from transportation services that are provided entirely by volunteers in their own cars to systems that use paid drivers in system-owned vehicles, some of which are accessible to travelers using wheelchairs (The Beverly Foundation and the Community Transportation Association of America, 2005). In 2001 the Foundation designated 11 programs as Senior Transportation Action Response (STAR) award winners (Beverly Foundation, AAA Foundation for Traffic Safety, 2001).

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

However, the Beverly Foundation report shows that even exemplary systems vary widely in terms of the number of clients served, the accessibility of their vehicles, and overall costs. At one end of the spectrum, a STAR system on a Native American reservation (San Felipe, New Mexico) provided 34,000 one-way trips to 90 people at an average cost of 57 cents per one-way trip; it had no vehicles accessible to individuals with disabilities. At the other end of the spectrum, a system in Portland, Oregon (Ride Connections), provided almost 200,000 one-way trips to 7,000 people at an average cost of over $28 for each trip; it had some vehicles accessible to individuals with disabilities. If weighted by the number of trips made, the average exemplary STP cost was $20.31 per one-way trip (in 2002 dollars) because larger STP systems with more riders had much higher costs.

In fact, three of the STAR systems had costs roughly comparable to those of public transit operators, although they were generally operating with many volunteers, sometimes using their volunteers’ cars. Gold Country Telecare (Grass Valley, California), Ride Connections (Portland, Oregon), and the Independent Transportation Network (ITN) (Westbrook, Maine) had average one-way trip costs that exceeded $27, even though all three (and particularly ITN) used some volunteer drivers. Of course, a number of variables may drive up costs; these providers serve large, low-density, or rural areas, which might mean that they must provide long and costly trips to distant medical and other facilities. The Gold County, California, system provided additional escort services, although the other two systems mentioned above did not. Ride Connection provided some services accessible to individuals with disabilities, which are generally more expensive. These systems may also face unique local or management challenges that may increase their expenditures.

However, while these systems are exemplary in their approaches to offering valuable mobility services for their older clients, it is clear that most of these 11 systems provide service to a small number of travelers. Moreover, the larger the system is, the higher the average costs are; many of the larger STAR systems had average costs equal to or only slightly less than those of large public transit agencies, even though all but one system used at least some volunteer drivers. These findings are consistent with those of other studies of social service agency transportation services (Siggerud, 2003; TCRP, 2004c). Moreover, a few of the 11 STAR systems do not appear to be in conformity with their obligations under ADA to provide the same level of transportation service to those needing accessible vehicles as they do to their more general riders. These data suggest, first, that even exemplary community services with substantial volunteer support can be expensive and, second, that it will require a very large number of such systems to meet the mobility needs of a growing population of disadvantaged travelers, particularly those with disabilities who need accessible vehicles.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Because these community-based transportation providers are so important to so many travelers—and have the potential to be even more important in the future—analysts have suggested a number of ways in which local communities might increase their number and effectiveness, reduce their costs, and ensure that they are able to offer services to those needing accessible vehicles. These suggestions include providing appropriate training to staff or volunteers in a variety of functional areas, from dispatching to dealing with the needs of travelers with significant disabilities. In addition, analysts have suggested ways to achieve cost savings through, for example, group purchase of insurance, vehicles, vehicle maintenance services, driver and dispatcher training, and computer dispatching programs (Ritter et al., 2002; Rosenbloom, 2005; The Beverly Foundation and the Community Transportation Association of America, 2005).

One approach to improving the delivery and lowering the cost of community-based transport services is coordination by encouraging or requiring active cooperation in some or all aspects of service delivery between and among the many transport providers in a community or region. Many small community transportation operators limit their services to a small number of agency clients, often restricting travel by trip purpose (medical or agency-related trips only), which results in the inefficient use of vehicles (and other facilities). This can clearly lead to high costs and, particularly in urban areas, substantial duplication and redundancies in service delivery (Siggerud, 2003; U.S. GAO, 2004). The conventional wisdom (Coordinating Council on Access and Mobility, 2000; Siggerud, 2003; U.S. GAO, 2004; TCRP, 2004c,d) is that community providers that are unwilling to cooperate with other providers in some or all aspects of transportation service delivery do so because they

believe that their funding sources forbid them from cooperating with other providers;

cannot figure out how to meet their financial and other reporting requirements if they provide services in different ways;

do not understand their own cost and service patterns well enough to see how coordinating with other community providers could save them money or increase the quantity or quality of service that they provide to their clients;

do not know about the coordination opportunities available in the community;

do not have the skills or experience to attempt greater cooperation in service delivery or other operational areas; or

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

both the national and the state levels to overcome these barriers through greater coordination among the federal agencies that fund transportation services, better information and training on a variety of the issues raised above, and the promotion of both voluntary and mandatory coordination programs. In the last few years there has been a flurry of executive and legislative activity at the national level. On February 1, 2001, President George W. Bush announced the New Freedom Initiative, designed to promote the full participation of people with disabilities in all areas of American life, including transportation. As part of its response, the U.S. Department of Transportation created an interagency working group to coordinate the many federal programs that fund transportation services for people with disabilities, produce a resource guide describing those programs, and develop examples of best practices in transportation service delivery that allow people with disabilities to get to work and job training.

In 2004 Presidential Executive Order 13330, the Coordination of Human Service Programs, created an independent interdepartmental Council on Access and Mobility to help reduce duplication among federally funded community transportation providers; increase the efficiency of their services; and expand the transportation access of a variety of disadvantaged travelers, including older people and those with disabilities. In 2006, the Safe, Accountable, Flexible, Efficient Transportation Equity Act (PL 109-59) went further and required local areas receiving funds for certain programs targeted at older people, those with disabilities, and poor people to prepare a plan for coordinating public transit and human service transportation in the area. Initial plans are required by 2007.

State and federal coordination efforts over the last three decades have helped many local providers to become more efficient and effective (TCRP, 2003a). Yet some analysts have noted that not all agencies that fail to coordinate with others are doing so for unacceptable reasons, and this may be most true for those providing service to travelers with disabilities. Some clients who need transportation may need more than just a ride (TCRP, 1997b, 2004c); many social agencies worry that without extra services some clients may choose not to travel or to use agency services at all (Rosenbloom and Warren, 1981; Rosenbloom, 1981). For example, some clients may need to be reminded several times of their appointments, helped with getting dressed or getting ready, encouraged to go to appointments or social events, etc.; without such additional assistance, they may miss or cancel their trips (McCray, 1998; Burke et al., 2004). Yet most organizations whose primary business is transportation are often unwilling or are unable to provide these additional services, at least without additional compensation (Carrasco, 2001; Griffin and Priddy, 2005).

In addition, not all areas have enough services to make major coordination efforts worthwhile; this may be particularly true in rural areas.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Some analysts have noted how difficult it is to set up and maintain effective coordinated programs without continuing financial assistance and leadership—as well as mandates—from regional or state agencies. The benefits of coordination are often diffused and are accompanied by some additional costs to the agencies involved, even if these additional costs occur only initially (Schlossberg, 2003, 2004). In short, while transportation coordination is clearly one way to help some community transport providers to become more efficient, it is not a panacea. Moreover, there are clearly instances in which coordination may lead to less mobility for travelers with disabilities.

Local Governments and the Pedestrian Environment

Most of the studies and surveys reported on in previous sections highlighted (1) the importance of walking to most travelers with disabilities and (2) how many barriers to mobility were created by problems in the pedestrian environment. However, improvements to pedestrian accessibility have lagged behind improvements to the rest of the transportation network, in part because no enforceable regulations for making the pedestrian (or public right-of-way) system accessible to travelers with either physical or visual impairments, or both, have been issued (although the U.S. Access Board has developed draft guidelines and has been working to improve industry standards for pedestrian facilities).

Most pedestrian facilities are built and maintained by local governments (or are required of developers in new areas by city or county subdivision ordinances). If these jurisdictions provide curb ramps, sidewalks, and/or bus stops, these elements must comply with the ADA. However, cities are not required to provide these pedestrian elements at any specific location if they do not exist. However, the ADA does require cities to undertake a program of providing access in their existing pedestrian facilities over time. Since almost 16 years have passed since the ADA requirements went into effect, many cities should have brought almost their entire pedestrian environments into compliance with the ADA.

Unfortunately, without enforceable standards, many communities have done the minimum. For example, they may provide some curb ramps and require all commercial and new residential developments to provide accessible sidewalks, but they rarely plan to substantially improve their existing sidewalks and bus stops if they can be viewed as accessible (and, arguably, in some cases, when they are not accessible). Moreover, many cities have been lax at properly maintaining the accessibility of the sidewalks and bus stops that do exist (repairing broken pavement or removing weeds and debris) or retrofitting built-up areas without sidewalks. They tend to be especially negligent about providing improvements critical to independent

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

mobility by those with visual impairments, such as audible pedestrian signals at stoplights and detectable warnings at curb ramps.

However, in early 2004, the 9th Circuit Court of Appeals overturned a lower court ruling that allowed the city of Sacramento, California, to argue that people with disabilities could use special paratransit services if they lacked accessible sidewalks to bus or tram stops. In Bardenet al.v.Sacramento (01-15744. DC No. CV 99-0497 MLS) the court ordered the city to address pedestrian barriers noting:

[The ADA] reveals a general concern for the accessibility of public sidewalks, as well as a recognition that sidewalks fall within the ADA’s coverage, and [the curb ramp requirement] would be meaningless if the sidewalks between the curb ramps were inaccessible…. Title II’s prohibition of discrimination in the provision of public services applies to the maintenance of public sidewalks.

The court mandated a fairly draconian remedy, ordering Sacramento to spend a fifth of its annual transportation fund budget for up to 30 years to meet the accessibility needs of pedestrians. The U.S. Supreme Court refused to hear the city’s appeal from the 9th Circuit; unless the Supreme Court accepts an appeal from another lower court and upholds the same standard, it is not clear how far-reaching this judicial decision will be.

In any case, the reality is that in many cities today people with disabilities lack an accessible route to an accessible transit facility. Because this situation has substantial mobility implications, several recent studies have suggested how communities can address deficiencies in their pedestrian networks to provide greater mobility for older people and those with disabilities, and these suggestions go beyond specific physical improvements. These suggestions begin, of course, by stressing the need to develop and maintain accessible pedestrian paths that link residential areas to one another and to commercial centers, as well as the need to provide access to transit facilities.

However, these studies and reports also stress enforcement, ensuring that cars are not parked in bus stops or on sidewalks and are not jutting out of driveways; using traffic-calming devices to lower traffic speeds and increase street attractiveness; and making both active and passive personal security efforts, that is, using police patrols (active) and design changes, enhanced lighting, and surveillance cameras (passive) to control on-street crime and harassment of pedestrians. Some studies have stressed the importance of using subdivision regulations and building codes to ensure the presence of accessible sidewalks in all new residential developments as well as commercial developments, while others have been concerned with retrofitting existing neighborhoods with accessible sidewalks and intersections, since so many older people are aging in place in older neighborhoods.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

The Private Transportation Sector

Title III of the ADA has the same effect on private transportation providers (except airlines) that Title II has on public entities (airline access is covered under the 1986 Air Carriers Access Act, although the accessibility requirements are different). Title III does not require private providers, such as hotel and airport shuttle services, to purchase accessible transport vehicles, as long as they provide an equivalent level of service to those with disabilities as they provide to the general public. The extent to which these private providers have met their ADA mandates is open to debate; many had to be sued, sometimes several times, before they found ways to provide equivalent levels of service and/or bought at least some accessible vehicles.

The ADA also does not require private taxi operators to own or operate accessible taxis for ordinary on-street taxi service, as long as their vehicles carry less than eight passengers or are purchased used. However, taxi operators may not otherwise discriminate against those with disabilities—such as by charging additional fees for storing wheelchairs or refusing to carry service animals. Most cities regulate taxi services in their jurisdictions; under pressure from advocacy groups, many now require local taxi companies to own and operate a certain number of accessible taxis in ordinary private-pay street operations so that people with disabilities who cannot ride in regular sedans can simply call a taxi like everyone else. Most accessible taxis are aftermarket conversions of ordinary vans; as such, they can cost from $5,000 to $15,000 more than the sedans usually used as taxis. Some cities provide vehicles or other incentives to taxi companies or individual drivers to buy and operate accessible taxis.

However, the extent to which even taxis bought with public subsidies are actually available to people with disabilities for regular on-street or phone service is open to question. First, accessible taxi service can rarely be better than the ordinary service onto which it is added, and taxi services are poor in many communities. Second, in some cities with accessible vehicles, most are kept busy under contract to the ADA paratransit system. Third, in some cities accessible taxis have been found sitting at the airport and refusing requests for service from people with disabilities not at the airport because those taxis will often be called to the front of the taxi line, perhaps for a traveler with a disability but, more likely, for large groups traveling together or skiers or golfers with bulky equipment. Finally, most experts agree that providing taxi services to people who need special vehicles is generally

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

less lucrative than providing ordinary services—independent of the cost of the vehicle—so some taxi drivers avoid passengers with disabilities even if they are operating an accessible taxi. In addition, passengers traveling with service animals often report that they are refused service (see a lengthy discussion of these issues in the report by NCD [2005]).

TRANSPORTATION AS PART OF A PACKAGE OF SOLUTIONS

The sections above have focused on ADA mandates in a variety of local transportation modes and the potential of these transportation modes to provide mobility for travelers with disabilities that is more frequent or better than that required by the ADA. This section focuses on the crucial nexus of direct transportation provision and a variety of other delivery systems for people with disabilities, highlighting the importance of seeing transportation services as inextricably linked to decisions made about many interrelated services and facilities—from how, where, and when medical services are provided to the strategies adopted by job training agencies.

Perhaps the most intractable issue in current debates is the tendency of those in every other substantive field from education to employment or from recreation to health care to assume that transportation deficiencies account for all or most of the underutilization of public and private services considered essential to the well-being of those with disabilities (see, for example, the work of Kenyon et al. [2003] and Lucas [2004]). In fact, substantial research shows that most people with disabilities face multiple barriers to both their mobility and their ability to get an education or a job or to access a range of public and private services from grocery stores to medical facilities. The causes of and solutions to these problems are complex; policy analysts must understand and address them in sophisticated ways that extend beyond public transit networks and, indeed, beyond transportation systems alone.

Of course, transportation problems are an important barrier to the mobility and access of those with disabilities. As the National Council on Disability has remarked,

Some people who are willing and able to work cannot do so because of inadequate transportation. Others cannot shop, socialize, enjoy recreational or spiritual activities, or even leave their homes. And some individuals with disabilities who need medical services must live in institutions due solely to the lack of safe, reliable transportation to needed medical services (NCD, 2005, p. 13).

It is unlikely, however, that transportation is the only problem or barrier facing most people with disabilities. For example, a lack of accessible transportation may create barriers to employment; but the failure to obtain

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

a meaningful job may also be the result of inadequate education and training, lack of experience, discrimination in the job market, or inadequate knowledge by employers about the kinds of reasonable accommodations that potential workers with disabilities require. Therefore, transportation services must be viewed and provided only as part of a package of supportive services and policies.

In the same vein, people with disabilities who lack accessible transportation may be unable to seek medical care in a timely way. Substantial research shows, however, that the “underutilization” of many kinds of medical and social services has a complicated variety of interrelated causes. Income and having health insurance (or Medicaid) are significant factors in service utilization; a 1996 study that used data from the 1987 Medical Expenditure Survey found that health status and having Medicaid benefits or private insurance were the most significant predictors of home health care (Kim, 1996). A 1997 study that used data from three national data sets on aging found that whether and how much older people used physicians and hospital services were consistently related to both their health status and having insurance (Miller et al., 1997).

A persistent research finding is that medical utilization rates differ significantly by race and ethnicity and that these differences are often independent of income or the availability of health insurance (Barnard and Pettigrew, 2003; Herbert et al., 2005; Jang et al., 2005; Welch et al., 2005). Roetzheim et al. (1999) attempted to explain the racial differences in the stage of the cancer when people were first diagnosed; the researchers found that neither insurance coverage nor socioeconomic status explained these racial differences. White-Means (1995) found that older African Americans were less likely to use emergency medical services than older white individuals with similar medical conditions and that these differences could not be explained by income or health status. White-Means (2000) also found clear racial differences in medical service utilization rates of people with disabilities that were not explained by socioeconomic variables. Wallace and colleagues (1998) observed that the “persistent effects of race/ethnicity [in medical service utilization] could be the result of culture, class, and/or discrimination.” This suggests that the cost of medical services and the way in which they are both delivered and perceived by the intended recipients are as crucial as the lack of transportation resources in the failure to use medical services.

Other studies show that older people underutilize a range of services targeted to them for reasons ranging from a feeling that the services cannot really help to a concern about service costs, even when those costs are substantially subsidized (Takahashi and Smutny, 2001; Ku, 2005; Ness et al., 2005). There is even evidence that many people resist using special

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

paratransit services because they fear being stigmatized or they do not believe that the services can or do meet their needs (Žakowska and Monterde, 2003; U.K. Department for Transport, Mobility and Social Inclusion Unit, 2006).

These findings still hold even when people say that transportation barriers prevent them from using medical or other services. Evashwick et al. (1984) concluded that when older people reported transportation difficulties, they were really reporting functional problems and not barriers to medical use. Rosenbloom (1978, 1982) suggested that older people reporting transportation barriers as the reason for the underutilization of medical services were using that reason to represent a bundle of problems, including an unwillingness to leave home, frustration with declining motor and other skills, an inability to pay for services, and unhappiness with the actual services offered, in addition to difficulty in accessing or obtaining transportation.

These observations are supported by early studies conducted for the U.S. Department of Transportation; when communities provided new medical and other transport services targeted at older people, ridership was almost entirely by people already making medical trips, presumably using a more problematic travel mode. That is, most new transport service users simply switched from whatever travel option that they had previously used to the new system, while very few of the people thought to be underutilizing services began to do so when they were provided with new transport options (Spear et al., 1978; Edelstein, 1979).

These findings may be linked to evidence that social and human service agencies must often provide more than just transportation to get their clients to leave home or use agency services (Burke et al., 2004). For example, McCray (1998) describes a special transport service in Detroit, Michigan, developed in response to the assumption that low-income pregnant women did not seek prenatal care because they lacked transportation. However, to actually get the intended riders to use the service, the female driver was required to offer incentives for the women to keep medical appointments, maintain records on the women’s pregnancies, and offer prenatal and spousal abuse counseling on the bus.

Clearly, transportation difficulties add to the other burdens that many people with disabilities face, and they may be a significant component of these problems; but unless we understand their relationship to personal, community, and service delivery constraints, we are unlikely to address the mobility problems that these travelers face. The lack of appropriate and accessible transportation interacts with a range of personal and societal barriers to reduce a person’s ability or willingness to leave home for a job, education, medical treatment, or socializing.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

SUMMARY AND CONCLUSIONS

Research clearly shows that travelers with disabilities face multiple barriers in every mode of travel, although we lack good data by severity of impairment, income, automobile ownership, and a range of socioeconomic characteristics. People with disabilities travel less and report more mobility problems than those without disabilities; moreover, almost 2 million Americans report themselves to be homebound. At the same time, the barriers that these travelers face are not necessarily the ones that have gained the most traction in policy debates, particularly debates that center on ADA modal mandates. For example, one-third of people with disabilities have no public transit or ADA-mandated paratransit available to them. The other two-thirds—who have access to these services—rarely use them and generally do not blame their nonuse on their disability. In addition, the travel mode that created the largest barriers for people with disabilities was walking, a mode necessary for the successful use of all other modes, as well as personal mobility.

In contrast, most travelers with disabilities said that they used a car for most of their trips, the majority as the driver of that car. That finding may not be surprising, since (1) many people unable to walk or use public transit can and do drive, and (2) the car provides greater convenience and flexibility than other modes for those with disabilities, as well as the general public (and, arguably, more so for those with disabilities). The dependence on the car was especially striking among older people; this is cause for alarm, given that many (but certainly not all) older drivers will be unable to continue to safely drive as they age because of increasing impairments and/or disabilities. Many older people have long depended on the car to maintain their lifestyles and may face serious mobility problems if and when they must stop driving. For that reason many studies have suggested policies and programs to enhance the driving skills of older drivers as well as making the driving task more manageable (through vehicle and highway modifications, for example).

People with disabilities have three sources of community-based transport: accessible transit and paratransit services provided by public transit agencies, those provided by myriad social and human service agency providers as well as municipal organizations, and those provided by the private sector. Each of these sets of services faces important ADA accessibility mandates, which are being met to greater or less degrees. However, each mode also has the potential to provide additional mobility and access for travelers with disabilities if additional funding can be found.

While access and mobility on all these modes have increased substantially since the 1990 passage of the ADA, each mode has ADA compliance problems and poses other barriers for travelers with disabilities. Not all key

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

stations on urban rail systems are yet accessible; even if they were, key stations are only a fraction of all stations in most urban rail systems. Almost all buses are accessible, but barriers to their use are posed by driver training and surveillance problems, as well as maintenance issues.

Complementary paratransit services are closer to meeting their mandates than they were in the past, but as costs have risen with compliance, many systems have reduced service to the minimum, raised fares to the maximum, and instituted rigorous certification processes that may have denied eligibility to people genuinely eligible while creating a chilling effect on others. Perhaps more important, the overwhelming majority of people with disabilities cannot use complementary paratransit services for a variety of reasons. This is in sharp contrast to a commonly held belief that such services are or could be an important part of the mobility of these travelers. The reality is that many people with disabilities who cannot use public transit will also be unable to use paratransit services.

Many regions host a wide variety of community-based transportation systems that provide an irreplaceable lifeline to the travelers with disabilities who can use them. However, while these systems all provide an invaluable service, many (certainly the larger) of these systems do so at costs not much cheaper than those charged by ADA paratransit providers, even though they use volunteer resources. More importantly, many provide limited services to a very small number of clients, often only for specific trip purposes. Moreover, some of the smaller community-based providers do not appear to be in conformity with their own ADA obligations to provide an equivalent level of service to travelers needing accessible vehicles. Overall, research suggests that we need to find ways to help some of these providers lower their costs and increase their effectiveness while expanding the number of community-based providers to meet the mobility needs of a growing population of disadvantaged travelers.

Significant improvements in the pedestrian network are also required because pedestrian barriers are the most frequently barriers cited by travelers with disabilities. All evidence suggests that ADA compliance with pedestrian (public right-of-way) systems may be low because we lack enforceable regulations in this area; as a result many people with disabilities lack an accessible route to an accessible bus stop. Research suggests the need to develop and maintain accessible and fully lit pedestrian paths while promoting greater enforcement of parking, safety, and security strategies.

Private transportation providers—including taxis and airport shuttles—have ADA mandates as well. Some evidence suggests, however, that these providers must be forced or given incentives to meet those mandates or to provide the levels of accessible services that are possible. While operators are not generally required to purchase and operate accessible taxis, many do so because of local regulations or local subsidies (or both). However, it is

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

not clear that accessible taxis are providing the level of service for travelers with disabilities that they might.

Finally, all evidence suggests that transportation is a necessary but not a sufficient condition for the full access and mobility of travelers with disabilities. Transportation planners must work in cooperation with both the public and the private sectors and with professionals in a variety of disciplines and service delivery systems (doctors and medical facilities; educators and training facilities; employment counselors and job search programs; and a wide variety of human, medical, and social service agencies and providers) to address the access and mobility needs of a range of travelers with disabilities.

ACKNOWLEDGMENTS

I am grateful to Marilyn Field for her guidance, patience, and support and to Marilyn Golden, Disability Rights Education and Defense Fund, for being willing to share her extraordinary knowledge in these areas. I am also grateful to two anonymous reviewers for their trenchant comments. Of course, the errors that remain are entirely my responsibility.

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Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

Suggested Citation:"Appendix G Transportation Patterns and Problems of People with Disabilities." Institute of Medicine. 2007. The Future of Disability in America. Washington, DC: The National Academies Press. doi: 10.17226/11898.

The future of disability in America will depend on how well the U.S. prepares for and manages the demographic, fiscal, and technological developments that will unfold during the next two to three decades.

Building upon two prior studies from the Institute of Medicine (the 1991 Institute of Medicine's report Disability in America and the 1997 report Enabling America), The Future of Disability in America examines both progress and concerns about continuing barriers that limit the independence, productivity, and participation in community life of people with disabilities. This book offers a comprehensive look at a wide range of issues, including the prevalence of disability across the lifespan; disability trends the role of assistive technology; barriers posed by health care and other facilities with inaccessible buildings, equipment, and information formats; the needs of young people moving from pediatric to adult health care and of adults experiencing premature aging and secondary health problems; selected issues in health care financing (e.g., risk adjusting payments to health plans, coverage of assistive technology); and the organizing and financing of disability-related research.

The Future of Disability in America is an assessment of both principles and scientific evidence for disability policies and services. This book's recommendations propose steps to eliminate barriers and strengthen the evidence base for future public and private actions to reduce the impact of disability on individuals, families, and society.

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